How many states are issuing OT Compact privileges?

Ten as of October 5, 2026: Minnesota, Ohio, West Virginia, Indiana, Virginia, Maryland, Tennessee, Wisconsin, Arkansas and Mississippi. Another 27 have enacted the compact but are not issuing yet.

Is an OT Compact privilege the same as a license?

Legally it is equivalent to one. The model law defines a compact privilege as an authorization equivalent to a license, and the remote state can discipline or remove it.

Do I need continuing education for every compact state?

No. The Commission's FAQ says practitioners only need to complete continuing education for their home state.

Does the OT Compact cover California, Texas, New York or Florida?

No. California, Texas and Florida are not members, and New York has only a bill filed. You need each state's own license to practice there.

The OT Compact, Explained for Occupational Therapists

Q: Can my employer or a service apply for my OT Compact privilege?

No. The Commission says employing agencies, third parties and other representatives may not legally complete the application. You create the account, complete it and pay yourself.

The OT Compact is an agreement among states that lets an occupational therapist or occupational therapy assistant licensed in one member state practice in other member states without getting a separate license in each. Instead of a license, you hold a "compact privilege," which the model law defines as an authorization "equivalent to a license." As of October 2026, 37 states have enacted the compact and 10 of them are issuing privileges, according to the OT Compact Commission's own map and its Before You Apply page (updated October 5, 2026). Everywhere else, you still need a regular state license.

The compact is useful, but narrower than most OTs expect. It works only if you live in a state that is issuing privileges, only for other states that are issuing privileges, and only while your home license stays current and clean. Each of those limits is covered below.

How does a compact privilege work?

The Occupational Therapy Licensure Compact model legislation, published by the Commission on otcompact.gov, sets the structure. Your home state is the member state where you have your primary residence and hold a license. Every other member state where you want to work is a remote state. You apply for a privilege in each remote state, and once it is granted you may practice there under that state's laws and rules (Section 4C of the model law).

Three ideas from the model law decide almost every question OTs ask us:

Practice happens where the patient is. Section 1 says "the Practice of Occupational Therapy occurs in the State where the patient/client is located at the time of the patient/client encounter." That is true for in-person care and for telehealth.
The privilege is equivalent to a license. It is not a courtesy or a temporary permit. The remote state can discipline it, fine you and remove it (Section 4E).
Everything hangs on the home license. The privilege is valid only until your home license expires (Section 4B), and it is deactivated if your home license is encumbered by discipline (Section 7H).

Which states can I use it in today?

Ten states were issuing privileges as of October 5, 2026, per the Commission's Before You Apply page:

Minnesota, Ohio and West Virginia (since January 12, 2026)
Indiana (March 9, 2026)
Virginia (March 20, 2026)
Maryland (April 15, 2026)
Tennessee (May 20, 2026)
Wisconsin (May 29, 2026)
Arkansas and Mississippi (October 5, 2026)

Another 27 states have enacted the compact but are not issuing yet. The Commission's FAQ is blunt about what that means: enactment "does not automatically approve your license for use in other states." Its homepage adds, "You cannot practice in an OTC state under the OT Compact, even if that state has enacted OTC legislation." We cover the difference in enacted is not issuing and keep the full list current in which states are issuing OT Compact privileges.

Eleven jurisdictions are not members at all, including California, Florida, New Jersey, Oregon, Texas and the District of Columbia. New York, Illinois and Massachusetts have bills filed but not enacted. If your work is in one of those places, the compact does nothing for you there; you need that state's license. Our state license index covers each one.

Who is eligible?

Section 4A of the model law lists the requirements, and the Commission's Before You Apply page restates them for applicants. In plain terms, you need:

A license in your home state, and that state must be a member that is issuing privileges.
No encumbrance on any state license you hold, not only the home one.
If you were ever disciplined, all fines paid and all terms completed, and two years elapsed since completion (Section 4A5).
A criminal background check through your home-state board, including an FBI fingerprint check. The Commission says its staff "does not conduct or facilitate CBCs." See the FBI background check for OT Compact privileges.
Any jurisprudence requirement the remote state sets. The Commission's table flags Kentucky, Maryland, Missouri, North Carolina, North Dakota, Ohio and Wisconsin. See jurisprudence requirements.
A valid Social Security number or NPI number.
Payment of the Commission fee and the state fee for each privilege.

The compact covers OTAs as well as OTs, with one extra rule: an OTA practicing in a remote state must be supervised by an OT licensed or holding a privilege in that remote state (Section 4D). More in the OT Compact for OTAs.

How do you apply, and who does the applying?

You apply through the Commission's data system, CompactConnect, not through a state board. The Commission's homepage says, "You do not apply for OTC privileges to practice through state licensing boards."

You also have to do it yourself. The Before You Apply page says the application contains legal attestations and that "Employing agencies, third party affiliates, and/or other representatives may not legally complete the application on behalf of licensees. Licensees should create their own accounts, complete the application, and make the payment themselves." That applies to staffing agencies, employers and services like ours. We explain what help is still allowed in can someone else apply for my OT Compact privilege?

In the application you attest that you have read each target state's practice act and rules, that you have completed any jurisprudence requirement, and which state is your home state. Those attestations are the reason the Commission insists the licensee completes it.

What does it cost?

Each privilege carries a $75 Commission fee (OTC Rule 6.1) plus whatever fee the remote state sets. For an OT, the state fees on the Before You Apply page range from $4 in Arkansas to $200 in Mississippi among the issuing states, with Maryland and Tennessee at $125 and Virginia and Wisconsin at $75. Both fees are paid together at the end of the application. Your home board's FBI background check is a separate cost. The full breakdown, including OTA fees, is in what an OT Compact privilege costs.

How long does a privilege last?

Until your home license expires, and no longer. The Commission's Before You Apply page says your privileges "expire when your HSL expires" and that "each time you renew your HSL, you will need to purchase a new OTC privilege." A policy that took effect September 10, 2026 adds that home-state grace periods do not count: the privilege ends on the home license's original expiration date. Details in renewing OT Compact privileges.

Continuing education is simpler. The Commission's FAQ says practitioners "only need to complete CEUs for their home state."

Where does the compact not help?

If you live in a non-member state. A Florida or Texas resident has no home state for compact purposes, even with a license from a member state. Section 3E says a license issued to someone not residing in a member state "shall not be recognized as granting the Compact Privilege."
If your home state is enacted but not issuing. A Pennsylvania or North Carolina resident has to wait for the home board to go live.
If the job is in a non-member state. No privilege exists for California, New York, Texas or Florida.
If you are moving, not visiting. Once you change your primary residence, the new state becomes your home state, and you need a home license there. See your home state and the OT Compact.
If your record has an encumbrance. The two-year waiting periods in Sections 4A5 and 4F apply.
If a school district or employer wants something more. Some states require a separate school credential that names a state license. See school-based OT credentials.

For many OTs the right answer is a mix: privileges for the issuing states, and a license by endorsement for the rest. We compare them in compact privilege or a state license?

Does Medicare accept a compact privilege?

CMS says yes. In MLN Matters SE20008 (revised September 16, 2021), CMS names the occupational therapy compact and says it will "treat licenses through the interstate license compact pathway as valid, full licenses for the purposes of meeting our federal license requirements." The CMS-855I enrollment form asks whether a reported license is a compact license. See Medicare enrollment for OTs.

Where do we fit?

We do not apply for privileges, sign attestations or pay compact fees for anyone; the Commission does not allow it. What we do is everything around the application. Our OT Compact Readiness Review ($149) checks whether your home state is issuing, whether your record qualifies, which target states are live and which need a jurisprudence exam. The Compact Privilege Concierge ($299 for the first privilege, $149 for each additional one) coordinates the FBI check with your home board, prepares you for jurisprudence, and walks you through CompactConnect in a guided session while you complete and submit the application yourself. State fees and the $75 Commission fee are paid by you, directly. For states outside the compact, see our state license guides or the OT Compact hub.